Diagnostic value of axillary artery ultrasound in patients with suspected giant cell arteritis. (2nd April 2020)

• Record Type: Journal Article
• Authors: Hop, Hilde; Mulder, Douwe J; Sandovici, Maria; Glaudemans, Andor W J M; van Roon, Arie M; Slart, Riemer H J A; Brouwer, Elisabeth
• Is Part Of: Rheumatology. Volume 59:Number 12(2020)
• Page Start: 3676
• Page End: 3684
• Publication Date: 2020-04-02
• Subjects: giant cell arteritis -- ultrasound -- diagnostic imaging; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keaa102
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: To compare colour duplex ultrasonography (CDU) findings with axillary 18 F-fluorodeoxyglucose (FDG) PET/CT findings and to compare the diagnostic performance of temporal and axillary artery CDU with temporal artery CDU alone. Methods: Patients suspected of GCA were retrospectively included. Presence of a halo or occlusion was considered a positive CDU finding. FDG-PET/CT-assessed axillary artery involvement was defined as axillary artery FDG uptake higher than liver uptake. The reference was the clinical diagnosis after 6 months, which was based on symptomatology and additional diagnostic tests, with the exception of CDU. Results: Of the 113 included patients, GCA was diagnosed in 41. Twenty-eight out of 41 GCA patients underwent a FDG-PET/CT. FDG-PET-assessed extra-cranial GCA was present in 20/41 patients, of which 13 showed axillary involvement on FDG-PET/CT. An axillary halo was found in eight of these 13 patients. Six out of the 20 patients with FDG-PET-assessed GCA showed no axillary involvement on CDU or FDG-PET/CT. Five of them had single artery involvement on FDG-PET/CT (two aorta; three vertebral artery). One patient had an axillary occlusion on CDU, consistent with FDG-PET/CT results. Overall, sensitivity and specificity of temporal artery CDU was 52% (95% CI: 35, 67) and 93% (95% CI: 84, 97), respectively. Adding axillary artery results improved sensitivity to 71% (95% CI: 55, 84), while specificity did not change. Conclusion: Presence of an axillary halo or occlusion on CDU is consistent with axillary artery FDG-PET/CT results, but a negative CDU does not rule out axillary involvement. Adding axillary artery assessment to temporal artery assessment may substantially increase the diagnostic performance of CDU.